The concentration of Botox cosmetic is less important than the actual number of units injected

Botox cosmetic is one of the most common cosmetic procedures performed in the United States.  At this time, the only FDA approved form of Botulinum toxin is manufactured by Allergan.  The standard vial contains one hundred units of Botox Type A in an undiluted form (powder form) prefilled in a vial.

Before use, a physician must constitute the Botox using sterile saline.  After dilution, the physician must calculate precisely the strength (or units) administered per amount injected.   At the time of injection, the physician should inform the patient of the approximate amount to be injected.

The efficacy of the Botox injected depends directly with the amount of units injected, the area of injection, and the technique used.  The dilution strength should not make a quantitative difference.

Anyone considering Botox should consult with an experienced physician or surgeon before undergoing any procedure. 

The concentration of Botox may vary from one doctor's office to the next, depending on the preference of the individual physician.  Some may choose a concentration of 4 units per 0.1cc, down to 1 unit per 0.1cc, all dependent upon the volume of saline that is mixed into the 100 unit Botox vial supplied by the manufacturer.  Assuming the doctor knows the relevant anatomy and the proper dosage, the concentration doesn't matter when it comes to achieving the desired treatment response.

Most patients have specific areas they want treated, and shouldn't be expected to know the proper dose.  However, there is only one truly ethical way of communicating the dose received, which is to tell the patient how many units were administered.  Doctors and offices may choose to price the Botox at a different cost per unit, depending on desired profit margin, office location, promotions, etc.  Since Botox is a drug, it is inappropriate to fail to make note of the dosage administered to a patient in the medical record.  Why would Botox be any different than an antibiotic or blood pressure medication in this regard?

Like a saloon in the wild west, the cowboys may not care if the whiskey is watered down as long as they still get drunk.  If the Botox treatments are effective, patients may not care whether they are being charged by the area or by the unit.  However, the only way to know for sure what you are actually getting, is to know the number of units per treatment, and the cost per unit.  Then, you can compare one saloon (oops, Doctor's Office) to the other ones down the street.

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Hi Elaine,

It is not the dilution of Botox that affects it's potency, but the number of units and it's proper placement.

It is important to choose your Botox injector carefully.  Not only has Botox been "watered down" by unethical practioners, clinics, and medispas, but there have been despicable characters injecting bogus Botox (in particular from an Arizona lab TRI that manufactured a "Botox for use in experimental animals only") that has resulted in hospitalizations and even death.

If you have doubts, don't return.  If the price seems too good to be true, then be suspicious.  Watch out for advertisements that sound more like a used car salesman than a physician.  Good luck and be well.

Dr. P

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Doctors can "water down" the Botox, without increasing the commensurate amount injected, or use Botox that is old. 

Signs of this are when the Botox appears to go away quickly, or frequent "touch-ups" are necessary when the initial dosage was not adequate.  Botox should also be administered in a medical setting, not a party or carnival environment.

While it may not seem to be a big deal to return frequently for repeat injections, there is some evidence that frequent low doses of Botox increases tolerance to the injections, and the Botox loses its effectiveness over time.

A reputable doctor will inject a strong amount of Botox in the right muscles.  He is not worried about the economics of how many units he is saving on by watering down the Botox.  His reputation is more important to him.

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